Patients with suspected myocardial infarction presenting to accident and emergency: an audit of clinical descriptions given by ambulance crews

Direct admission to coronary care is an important part of a strategy to increase the use of thrombolysis and to reduce door-to-needle time. The National Service Framework describes this approach as the optimal mode of care for thrombolysis treatment delivery. In trusts where such a strategy is adopted, reliance is placed on the referral agency to appropriately triage chest pain patients. We therefore conducted an audit over three consecutive months of ambulance report forms of patients brought to the accident and emergency department who were subsequently diagnosed, treated and transferred to coronary care as having had an acute myocardial infarction. Of 36 patients who formed the audit group, 11 patients could have been triaged to go directly to the coronary care unit. Review of the remainder revealed some of the difficulties faced by ambulance personnel in clinically assessing myocardial infarction patients. This audit confirms the need to reinforce adherence to the locally agreed protocol and to positively encourage ambulance personnel to admit directly to coronary care units.